2016 年第 1 期 第 14 卷

误诊为脊柱关节炎的急性淋巴细胞白血病7例临床分析

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关键词：急性淋巴细胞白血病脊柱关节炎

• 摘要：
• 【摘要】【目的】探讨急性淋巴细胞白血病误诊为脊柱关节炎的原因，以提高对其认识，利于早期诊断。【方法】回顾性分析2008年至2015年我科住院曾被误诊为脊柱关节炎(SPA)后经骨髓检查确诊急性淋巴细胞白血病(ALL)病人7例，分析其临床表现、实验室检查及影像学检查结果。【结果】7例中男性6人，女性1人，年龄16～43岁，病程2个月～24个月，5/7例伴下腰背疼痛，5/7例伴有发热，3/7例少关节炎型，4/7例多关节炎型。3/7例有浅表淋巴结肿大。2/7例轻度贫血， 6/7例血沉增快，7例均C反应蛋白升高。影像学3/7例有骶髂关节炎表现，1/7例有双侧股骨头缺血坏死，1/7例有髋关节炎，1/7例膝关节X线可见长骨干骺端透光带，3例行全身骨扫描检查。【结论】遇有发热、骨痛、NSAIDs治疗无效，即使外周血细胞正常也应进行骨髓检查；全身骨扫描检查有较强的提示作用。
• [Objective]To explore the reason of misdiagnosis of acute lymphatic leukemia as spondyloarthritis and improve the cognition for early diagnosis.[Medthods]7cases of ALL which all misdiagnosed as SPA in our hospital during 2008～2015 were analyzed restrospectively.Clinical features including initial presentation,involved joints,laboratory tests,and radiological image data were analyzed.[Results]Among the 7 cases,6 were male and 1 was female.5 patients got low back pain and fever.3 cases were less arthritis and 4 were more arthritis.3 patients had superficial lymph nodes.2 patients were anemia in the blood routine test.Most patients were abnormal in erythrocyte sedimentation rate and C-reaction protein.3 patients were accompanied by sacroiliitis in radiological image check.1 patient was accompanied by avascular necrosis of femoral head and 1 was accompanied by osphyarthrosis.Radiolucent metaphyseal bands were seen among 1of 7 cases.[Conclusion]Patient with arthralgia or arthritis which has underfined cause, accompanied by fever and poor response to standard management should be considered the possibility of leckemia even when the blood routine is normal.Related examinations should be take.